Autism is a disorder that is usually
first diagnosed in early childhood. The
main signs and symptoms of autism
involve communication, social
interactions and repetitive behaviors.

Children with autism might have
problems talking with you, or they might
not look you in the eye when you talk to
them. They may have to line up their
pencils before they can pay attention,
or they may say the same sentence again
and again to calm themselves down. They
may flap their arms to tell you they are
happy, or they might hurt themselves to
tell you they are not. Some people with
autism never learn how to talk.

Because people with autism can have
very different features or symptoms,
health care providers think of autism as
a "spectrum" disorder.
Asperger syndrome is a milder
version of the disorder.

The cause of autism is not known.
Autism lasts throughout a person's
lifetime. There is no cure, but
treatment can help. Treatments include
behavior and communication therapies and
medicines to control symptoms.

What is autism?

Autism (sometimes
called “classical
autism”) is the most
common condition in
a group of
developmental
disorders known as
the autism spectrum
disorders (ASDs).
Autism is
characterized by
impaired social
interaction,
problems with verbal
and nonverbal
communication, and
unusual, repetitive,
or severely limited
activities and
interests. Other
ASDs include
Asperger syndrome,
Rett syndrome,
childhood
disintegrative
disorder, and
pervasive
developmental
disorder not
otherwise specified
(usually referred to
as PDD-NOS).
Experts estimate
that three to six
children out of
every 1,000 will
have autism. Males
are four times more
likely to have
autism than females.

What are some common
signs of autism?

There are three
distinctive
behaviors that
characterize
autism. Autistic
children have
difficulties with
social interaction,
problems with verbal
and nonverbal
communication, and
repetitive behaviors
or narrow, obsessive
interests. These
behaviors can range
in impact from mild
to disabling.

The hallmark feature
of autism is
impaired social
interaction.
Parents are usually
the first to notice
symptoms of autism
in their child. As
early as infancy, a
baby with autism may
be unresponsive to
people or focus
intently on one item
to the exclusion of
others for long
periods of time. A
child with autism
may appear to
develop normally and
then withdraw and
become indifferent
to social
engagement.

Children with autism
may fail to respond
to their name and
often avoid eye
contact with other
people. They have
difficulty
interpreting what
others are thinking
or feeling because
they can’t
understand social
cues, such as tone
of voice or facial
expressions, and
don’t watch other
people’s faces for
clues about
appropriate
behavior. They lack
empathy.

Many children with
autism engage in
repetitive movements
such as rocking and
twirling, or in
self-abusive
behavior such as
biting or
head-banging. They
also tend to start
speaking later than
other children and
may refer to
themselves by name
instead of “I” or
“me.” Children with
autism don’t know
how to play
interactively with
other children.
Some speak in a
sing-song voice
about a narrow range
of favorite topics,
with little regard
for the interests of
the person to whom
they are speaking.

Many children with
autism have a
reduced sensitivity
to pain, but are
abnormally sensitive
to sound, touch, or
other sensory
stimulation. These
unusual reactions
may contribute to
behavioral symptoms
such as a resistance
to being cuddled or
hugged.

Children with autism
appear to have a
higher than normal
risk for certain
co-existing
conditions,
including fragile X
syndrome (which
causes mental
retardation),
tuberous sclerosis
(in which tumors
grow on the brain),
epileptic seizures,
Tourette syndrome,
learning
disabilities, and
attention deficit
disorder. For
reasons that are
still unclear, about
20 to 30 percent of
children with autism
develop epilepsy by
the time they reach
adulthood. While
people with
schizophrenia may
show some
autistic-like
behavior, their
symptoms usually do
not appear until the
late teens or early
adulthood. Most
people with
schizophrenia also
have hallucinations
and delusions, which
are not found in
autism.

How is autism
diagnosed?

Autism varies widely
in its severity and
symptoms and may go
unrecognized,
especially in mildly
affected children or
when it is masked by
more debilitating
handicaps. Doctors
rely on a core group
of behaviors to
alert them to the
possibility of a
diagnosis of
autism. These
behaviors are:

impaired
ability to
make friends
with peers

impaired
ability to
initiate or
sustain a
conversation
with others

absence or
impairment
of
imaginative
and social
play

stereotyped,
repetitive,
or unusual
use of
language

restricted
patterns of
interest
that are
abnormal in
intensity or
focus

preoccupation
with certain
objects or
subjects

inflexible
adherence to
specific
routines or
rituals

Doctors will often
use a questionnaire
or other screening
instrument to gather
information about a
child’s development
and behavior. Some
screening
instruments rely
solely on parent
observations; others
rely on a
combination of
parent and doctor
observations. If
screening
instruments indicate
the possibility of
autism, doctors will
ask for a more
comprehensive
evaluation.

Autism is a complex
disorder. A
comprehensive
evaluation requires
a multidisciplinary
team including a
psychologist,
neurologist,
psychiatrist, speech
therapist, and other
professionals who
diagnose children
with ASDs. The team
members will conduct
a thorough
neurological
assessment and
in-depth cognitive
and language
testing. Because
hearing problems can
cause behaviors that
could be mistaken
for autism, children
with delayed speech
development should
also have their
hearing tested.
After a thorough
evaluation, the team
usually meets with
parents to explain
the results of the
evaluation and
present the
diagnosis.

Children with some
symptoms of autism,
but not enough to be
diagnosed with
classical autism,
are often diagnosed
with PDD-NOS.
Children with
autistic behaviors
but well-developed
language skills are
often diagnosed with
Asperger syndrome.
Children who develop
normally and then
suddenly deteriorate
between the ages of
3 to 10 years and
show marked autistic
behaviors may be
diagnosed with
childhood
disintegrative
disorder. Girls
with autistic
symptoms may be
suffering from Rett
syndrome, a
sex-linked genetic
disorder
characterized by
social withdrawal,
regressed language
skills, and hand
wringing.

What causes autism?

Scientists aren’t
certain what causes
autism, but it’s
likely that both
genetics and
environment play a
role. Researchers
have identified a
number of genes
associated with the
disorder. Studies
of people with
autism have found
irregularities in
several regions of
the brain. Other
studies suggest that
people with autism
have abnormal levels
of serotonin or
other
neurotransmitters in
the brain. These
abnormalities
suggest that autism
could result from
the disruption of
normal brain
development early in
fetal development
caused by defects in
genes that control
brain growth and
that regulate how
neurons communicate
with each other.
While these findings
are intriguing, they
are preliminary and
require further
study. The theory
that parental
practices are
responsible for
autism has now been
disproved.

What role does
inheritance play?

Recent studies
strongly suggest
that some people
have a genetic
predisposition to
autism. In families
with one autistic
child, the risk of
having a second
child with the
disorder is
approximately 5
percent, or one in
20. This is greater
than the risk for
the general
population.
Researchers are
looking for clues
about which genes
contribute to this
increased
susceptibility. In
some cases, parents
and other relatives
of an autistic child
show mild
impairments in
social and
communicative skills
or engage in
repetitive
behaviors.
Evidence also
suggests that some
emotional disorders,
such as manic
depression, occur
more frequently than
average in the
families of people
with autism.

Do symptoms of
autism change over time?

For many children,
autism symptoms
improve with
treatment and with
age. Some children
with autism grow up
to lead normal or
near-normal lives.
Children whose
language skills
regress early in
life, usually before
the age of 3, appear
to be at risk of
developing epilepsy
or seizure-like
brain activity.
During adolescence,
some children with
autism may become
depressed or
experience
behavioral
problems. Parents
of these children
should be ready to
adjust treatment for
their child as
needed.

How is autism treated?

There is no cure for
autism. Therapies
and behavioral
interventions are
designed to remedy
specific symptoms
and can bring about
substantial
improvement. The
ideal treatment plan
coordinates
therapies and
interventions that
target the core
symptoms of autism:
impaired social
interaction,
problems with verbal
and nonverbal
communication, and
obsessive or
repetitive routines
and interests. Most
professionals agree
that the earlier the
intervention, the
better.

Educational/behavioral
interventions:
Therapists
use highly
structured
and
intensive
skill-oriented
training
sessions to
help
children
develop
social and
language
skills.
Family
counseling
for the
parents and
siblings of
children
with autism
often helps
families
cope with
the
particular
challenges
of living
with an
autistic
child.

Medications:
Doctors
often
prescribe an
antidepressant
medication
to handle
symptoms of
anxiety,
depression,
or
obsessive-compulsive
disorder.
Anti-psychotic
medications
are used to
treat severe
behavioral
problems.
Seizures can
be treated
with one or
more of the
anticonvulsant
drugs.
Stimulant
drugs, such
as those
used for
children
with
attention
deficit
disorder
(ADD), are
sometimes
used
effectively
to help
decrease
impulsivity
and
hyperactivity.

Other
therapies:
There are a
number of
controversial
therapies or
interventions
available
for autistic
children,
but few, if
any, are
supported by
scientific
studies.
Parents
should use
caution
before
adopting any
of these
treatments.

What research is
being done?

The National
Institute of
Neurological
Disorders and Stroke
(NINDS) is one of
the federal
government’s leading
supporters of
biomedical research
on brain and nervous
system disorders.
The NINDS conducts
research in its
laboratories at the
National Institutes
of Health in
Bethesda, Maryland, and also awards grants to support research at universities and
other facilities.

As part of the
Children’s Health
Act of 2000, the
NINDS and three
sister institutes
have formed the NIH
Autism Coordinating
Committee to expand,
intensify, and
coordinate NIH’s
autism research.
Eight dedicated
research centers
across the country
have been
established as
“Centers of
Excellence in Autism
Research” to bring
together researchers
and the resources
they need. The
Centers are
conducting basic and
clinical research,
including
investigations into
causes, diagnosis,
early detection,
prevention, and
treatment, such as
the studies
highlighted below:

investigators
are using animal
models to study
how the
neurotransmitter
serotonin
establishes
connections
between neurons
in hopes of
discovering why
these
connections are
impaired in
autism

researchers are
testing a
computer-assisted
program that
would help
autistic
children
interpret facial
expressions

a brain imaging
study is
investigating
areas of the
brain that are
active during
obsessive/repetitive
behaviors in
adults and very
young children
with autism

other imaging
studies are
searching for
brain
abnormalities
that could cause
impaired social
communication in
children with
autism

clinical studies
are testing the
effectiveness of
a program that
combines parent
training and
medication to
reduce the
disruptive
behavior of
children with
autism and other
ASDs

For more information
on neurological
disorders or research
programs funded by the
National Institute of
Neurological Disorders
and Stroke, contact the
Institute's Brain
Resources and
Information Network
(BRAIN) at: